scholarly journals Clinical outcome of selective amygdalectomy in a series of patients with resistant temporal lobe epilepsy

2021 ◽  
Vol 12 ◽  
pp. 575
Author(s):  
Guive Sharifi ◽  
Mohammad Hallajnejad ◽  
Samaneh Sadat Dastgheib ◽  
Mahmoud Lotfinia ◽  
Omidvar Rezaei Mirghaed ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Anterior Part ◽  
Effective Control ◽  
Middle Temporal Gyrus ◽  
Unusual Complication ◽  
Middle Temporal ◽  
Selective Amygdalohippocampectomy ◽  
Amygdala Lesions

Background: Selective amygdalohippocampectomy is one of the main approaches for treating medial temporal lobe epilepsy (TLE). We herewith describe seven cases of amygdala lesions treated with selective amygdalectomy with the hippocampus saving procedure. Furthermore, we explain the trans-middle temporal gyrus transventricular approach for selective amygdalectomy. Methods: We studied patients with TLE who underwent selective amygdalectomy with hippocampal saving procedure between March 2012 and July 2018. We preferred the trans-middle temporal gyrus transventricular approach. We adopted pterional craniotomy with extensive exposure of the base and posterior of the temporal lobe. The posterior margin of resection in the intraventricular part of the amygdala was considered the inferior choroidal point. Medially anterior part of the uncus was resected until reaching the ambient cistern. We applied the transcortical transventricular approach for selective amygdalectomy in all patients. Results: We present 11 cases having an amygdala lesion in our series, seven of whom underwent selective amygdalectomy with hippocampal sparing. Nine patients had neoplastic lesions, and in two of them, gliosis was evident. Total resection of the lesion was achieved in all cases based on postoperative magnetic resonance imaging. No unusual complication or surgically-related new neurological deficit occurred. Conclusion: We consider the resection of the amygdala until the inferior choroidal point sufficient for the disconnection of its circuits, which results in more effective control of seizures and reduction of surgery time and complications.

scholarly journals Evaluation of Brain Structure Based on Voxel and Surface Morphology in Adults with MRI Negative Temporal Lobe Epilepsy

2022 ◽  
Author(s):  
Fan Yang ◽  
Hanjiaerbieke Kukun ◽  
Wenxiao Jia ◽  
Shuang Ding ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Gray Matter ◽  
Age Of Onset ◽  
Morphological Changes ◽  
Fusiform Gyrus ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Control Group ◽  
Middle Temporal

Abstract Background MRI-negative TLE (TLE-N) is a manifestation lacks visible MRI findings yet with detectable electrophysiological changes. In this study, differences of gray matter in drug-controlled MRI negative temporal lobe epilepsy (cTLE-N) and drug-resistant MRI negative temporal lobe epilepsy (rTLE-N) patients were calculated and analyzed by voxel-based morphology (VBM) and surface-based morphology (SBM), to discover the brain structural changes of TLE-N patients. Materials and methods Consecutive resident patients with 30 cTLE-N and 21 rTLE-N were recruited into respective groups, and 30 healthy controls’ structural MRI (sMRI) data collected as a control group. Open-source software based on VBM and SBM was deployed as gray matter volume (GMV) and cortical thickness (CT) analytic tools. Results VBM analysis showed that GMV of bilateral thalamus and right lingual gyrus of cTLE-N group, and left hippocampus, left fusiform gyrus and left thalamus of rTLE-N group were smaller compared to HC group(FDR corrected, P<0.05), while right cerebellum, inferior temporal gyrus, hippocampus, parahippocampal gyrus, amygdala, fusiform gyrus, orbital middle frontal gyrus, and left posterior central gyrus in cTLE-N group, and bilateral cerebellum and middle temporal gyrus, right fusiform gyrus, amygdala, hippocampus, and left middle occipital gyrus of rTLE-N group were greater than HC group(FDR corrected, P<0.05). SBM analysis showed that CT of the left medial orbitofrontal cortex and lateral occipital cortex in cTLE-N group, and thickness of the left medial orbitofrontal, temporal pole, middle temporal gyrus and right anterior superior cingulate cortex in rTLE-N group were thinner, compared to HC group. Correlation analysis showed that GMV and CT of different structures were correlated with age of onset, disease duration, and MoCA score. Conclusion This study utilized two different sMRI analytic tools and discovered several brain morphological changes in TLE-N. These morphological changes were also correlated with clinical variables. Further study may indicate the potential of these findings on the recognition of the TLE-N epilepsy network.

scholarly journals Cortical projection of the inferior choroidal point as a reliable landmark to place the corticectomy and reach the temporal horn through a middle temporal gyrus approach

2014 ◽  
Vol 72 (10) ◽  
pp. 777-781 ◽  
Author(s):  
Thomas Frigeri ◽  
Albert Rhoton ◽  
Eliseu Paglioli ◽  
Ney Azambuja
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Cerebral Hemispheres ◽  
Middle Temporal Gyrus ◽  
Cortical Projection ◽  
Anatomical Features ◽  
Middle Temporal ◽  
Temporal Horn ◽  
Mesial Temporal Lobe

Objective To establish preoperatively the localization of the cortical projection of the inferior choroidal point (ICP) and use it as a reliable landmark when approaching the temporal horn through a middle temporal gyrus access. To review relevant anatomical features regarding selective amigdalohippocampectomy (AH) for treatment of mesial temporal lobe epilepsy (MTLE). Method The cortical projection of the inferior choroidal point was used in more than 300 surgeries by one authors as a reliable landmark to reach the temporal horn. In the laboratory, forty cerebral hemispheres were examined. Conclusion The cortical projection of the ICP is a reliable landmark for reaching the temporal horn.

scholarly journals A.06 Selective amygdalohippocampectomy in pediatric medically refractory temporal lobe epilepsy yields worse seizure outcomes

2017 ◽  
Vol 44 (S2) ◽  
pp. S10-S10
Author(s):  
CA Elliott ◽  
D Sinclair ◽  
A Broad ◽  
K Narvacan ◽  
T Steve ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Neuropsychological Testing ◽  
Temporal Lobectomy ◽  
Middle Temporal Gyrus ◽  
Seizure Freedom ◽  
Average Delay ◽  
Selective Amygdalohippocampectomy ◽  
Initial Surgery

Background: Selective amygdalohippocampectomy (SAH) is a surgical option in well-selected cases of pediatric medically refractory temporal lobe epilepsy (TLE). The objective of this study was to compare the surgical outcome and the rate of reoperation for ongoing or recurrent seizures between SAH and anterior temporal lobectomy (ATL) in pediatric TLE. Methods: Retrospective review of 78 pediatric intractable TLE patients referred to the Comprehensive Epilepsy Program at our institution between 1988 and 2015 treated initially with either a trans-middle temporal gyrus SAH (19) or ATL (59). Patients underwent baseline long-term video electroencephalography and 1.5-Tesla MRI. Neuropsychological testing was performed preoperatively and 12-months postoperatively (including reoperations). Results: The mean follow-up was 64 months (range, 12-186 months). The average age at initial surgery was 10.6±5 years with an average delay of 5.7±4 years between seizure onset and surgery. Ultimately 78% were seizure-free (61/78) at most recent follow-up. Seizure freedom after initial surgical treatment was achieved in 81% of patients who underwent ATL (48 patients) versus 42% in SAH (8 patients; p<0.001). Of patients with ongoing disabling seizures following SAH, reoperation (ATL) was offered in 8 resulting in seizure freedom in 63%, without interval neuropsychological decline. Conclusions: SAH amongst well-selected pediatric TLE results in significantly worse seizure control compared with ATL.

The function of medial temporal lobe and posterior middle temporal gyrus in forming creative associations

Hippocampus ◽  
2020 ◽  
Vol 30 (12) ◽  
pp. 1257-1267
Author(s):  
Ze Zhang ◽  
Lulu Liu ◽  
Yue Li ◽  
Tengteng Tan ◽  
Kazuhisa Niki ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Middle Temporal Gyrus ◽  
Middle Temporal

Selective amygdalohippocampectomy: the trans-middle temporal gyrus approach

2008 ◽  
Vol 25 (3) ◽  
pp. E4 ◽  
Author(s):  
B. Matt Wheatley
Keyword(s):  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Parahippocampal Gyrus ◽  
Middle Temporal Gyrus ◽  
Anterior Temporal Lobectomy ◽  
Middle Temporal ◽  
Selective Amygdalohippocampectomy ◽  
Temporal Structures ◽  
Mesial Temporal Lobe ◽  
Temporal Neocortex

The most common surgical procedure for the mesial temporal lobe is the standard anterior temporal resection or what is commonly called the anterior temporal lobectomy. There are, however, a number of other more selective procedures for removal of the mesial temporal lobe structures (amygdala, hippocampus, and parahippocampal gyrus) that spare much of the lateral temporal neocortex. Included in these procedures collectively referred to as selective amygdalohippocampectomy are the transsylvian, subtemporal, and transcortical (trans-middle temporal gyrus) selective amygdalohippocampectomy. In this manuscript the author reviews some of the surgical details of the trans-middle temporal gyrus approach to the mesial temporal structures.

scholarly journals Multi-scale image analysis and prediction of visual field defects after selective amygdalohippocampectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bastian David ◽  
Jasmine Eberle ◽  
Daniel Delev ◽  
Jennifer Gaubatz ◽  
Conrad C. Prillwitz ◽  
...  
Keyword(s):  
Visual Field ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Diffusion Tensor ◽  
Global Network ◽  
Visual Field Defects ◽  
Whole Brain ◽  
Network Analyses ◽  
Postoperative Mri ◽  
Selective Amygdalohippocampectomy

AbstractSelective amygdalohippocampectomy is an effective treatment for patients with therapy-refractory temporal lobe epilepsy but may cause visual field defect (VFD). Here, we aimed to describe tissue-specific pre- and postoperative imaging correlates of the VFD severity using whole-brain analyses from voxel- to network-level. Twenty-eight patients with temporal lobe epilepsy underwent pre- and postoperative MRI (T1-MPRAGE and Diffusion Tensor Imaging) as well as kinetic perimetry according to Goldmann standard. We probed for whole-brain gray matter (GM) and white matter (WM) correlates of VFD using voxel-based morphometry and tract-based spatial statistics, respectively. We furthermore reconstructed individual structural connectomes and conducted local and global network analyses. Two clusters in the bihemispheric middle temporal gyri indicated a postsurgical GM volume decrease with increasing VFD severity (FWE-corrected p < 0.05). A single WM cluster showed a fractional anisotropy decrease with increasing severity of VFD in the ipsilesional optic radiation (FWE-corrected p < 0.05). Furthermore, patients with (vs. without) VFD showed a higher number of postoperative local connectivity changes. Neither in the GM, WM, nor in network metrics we found preoperative correlates of VFD severity. Still, in an explorative analysis, an artificial neural network meta-classifier could predict the occurrence of VFD based on presurgical connectomes above chance level.

scholarly journals How common is brain atrophy in patients with medial temporal lobe epilepsy?

Epilepsia ◽  
2010 ◽  
Vol 51 (9) ◽  
pp. 1774-1779 ◽  
Author(s):  
Leonardo Bonilha ◽  
Jordan J. Elm ◽  
Jonathan C. Edwards ◽  
Paul S. Morgan ◽  
Christian Hicks ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Brain Atrophy ◽  
Medial Temporal Lobe ◽  
Medial Temporal Lobe Epilepsy
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